Organization
LOGAN COMMUNITY RESOURCES, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SHARRON CARTER (CFO)
(574) 289-4831
Entity
Organization
Contact information
Practice address
2505 E JEFFERSON BLVD, SOUTH BEND, IN 46615-2635
(574) 289-4831
(574) 234-2075
Mailing address
2505 E JEFFERSON BLVD, SOUTH BEND, IN 46615-2635
(574) 289-4831
(574) 234-2075
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201036530
—
IN
Enumeration date
12/13/2011
Last updated
12/13/2011
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